Lecturer in Microbiology, Cardiff Metropolitan University
Sarah Maddocks does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Cardiff Metropolitan University provides funding as a member of The Conversation UK.
Human experience is undoubtedly marked with wounds, ranging from trivial paper cuts to severe injuries on the battlefield. An ever-present threat within these wounds is infection, a foe we’ve been battling since the age of antiquity.
Due to the inherent risk of injury during warfare, there was an ongoing quest to discover novel methods to fight wound infections. However, early surgical interventions had to make do without the sterile tools we have today. Therefore, surgery posed the additional threat of subsequent wound infection, leading to an alarming number of fatalities.
Ancient treatment methods around 2000BC commonly employed substances like oils, mud, turpentine, or honey on wounds. The renowned Greek physician Hippocrates (460-377BC) applied vinegar to cleanse wounds, which was subsequently covered with bandages to prevent dirt accumulation.
In the medieval period, the first hospitals were founded in Europe. However, they were more perilous and violent than therapeutic. The unsanitary conditions and the use of cautery (technique of burning a part of a patient’s wound till it touched the bone) resulted in high rates of wound infections.
During the 1860s, the innovative work of Joseph Lister led to a significant change in the approach to treating wound infections. Lister introduced the concept of using bandages soaked in carbolic acid. More about this. Furthermore, Robert Wood Johnson, the founder of renowned company Johnson & Johnson, managed to produce sterile gauge bandages by 1890. This unique blend of sterile bandaging and antiseptics set the stage for a new era in wound treatment and infection control.
The discovery of penicillin by Alexander Fleming in 1928 would become a landmark moment in treating wound infections. By the 1940s, penicillin was increasingly used to treat soldiers of the second world war, saving countless lives from wound infections that were previously deemed untreatable. However, for minor wounds, Lister’s innovative technique of using a sterile dressing and an antiseptic persisted.
Compounds such as silver, and iodine, have been appreciated for their antimicrobial properties since the 1800s. Iodine, despite being effective, caused discomfort and skin discoloration until 1949 when safer, less harsh versions were developed. These newer versions are still present in modern wound dressing materials.
Treating everyday cuts and scrapes usually only requires cleaning with water followed by the application of antiseptic cream. This practice can help reduce the chances of bacteria entering the wound, hence it reduces the potential risk of additional pain and swelling.
Despite most present-day wounds healing without complications, some unfortunately fester into infections. According to research released in 2021, a staggering 3.8 million individuals had their wounds looked after by the NHS between 2017 and 2018, marking a 71% increase from the period between 2012 and 2013. Wounds treated ranged from surgical injuries, leg ulcers to burns, painting a sober picture of the difficult nature of managing hard-to-heal wounds and their high susceptibility to infections.
The rise of antibiotic resistance has emerged as one of the most significant obstacles in current wound infection treatments. Antibiotic resistance occurs when bacteria evolve to resist drugs originally made to eliminate them. This leads to severe difficulties in treatment and, in some cases, leaves the infection incurable.
Furthermore, many bacteria have also developed resistance to the antimicrobial components found in wound dressings, especially in silver-based ones. These are frequently used to treat persistent wound infections. Such wounds typically fail to heal over an extended period, sometimes dragging on for years. This not only severely hampers the inflicted individual’s quality of life but also poses a significant financial strain on the NHS.
The unwavering battle against wound infections necessitates continuous research for safer and more efficient treatment methods. While there have been advancements, a significant barrier still exists in the form of limitations in laboratory testing procedures. These tests, although vital for obtaining regulatory approval, often fall short of mimicking the complex realities of wounds in the human body.
No two people are the same and no two wounds are the same either. This can lead to situations where treatments shine in the lab but ultimately prove ineffective in real patients.
In response to this, scientists are tackling the limitations of lab tests by creating more realistic synthetic wound models. Some are even 3D printing human skin (using leftovers from surgical procedures), or animal skin, complete with artificial body fluids, such as pus. The aim is to create a model environment that mimics real wounds more accurately.
Recently, my own research group has made strides in developing lab models that act like real chronic wounds when treated with antimicrobial dressings. While not perfect, our models are a step in the right direction, contributing to the development of formulations with promising potential for treating wound infections in the future.
As we navigate the complexities of wound care, the quest for new, effective and safe treatments continues, driven by the efforts of scientists worldwide. We are working towards a future where the management of difficult-to-heal wounds and infections improves, enhancing both individual wellbeing and the efficiency of health systems.